Working to Be a Leader

May is Borderline Personality Disorder Awareness Month.  Thanks to the efforts of Perry Hoffman, Ph.D., President, and members of the Board of Directors of the National Education Alliance for Borderline Personality Disorder (NEA-BPD), the U.S. House of Representatives on April 1, 2008, acknowledged the need to bring the attention of the disorder that impacts all areas of one’s life to the attention of the general public.  “All aspects of one’s life” include the workplace where managers are often at a loss to know why employees act out, demonstrate wide mood swings, or engage in self-destructive behaviors.   Below is information that may help you understand your staff better.

Perry Hoffman; Marsha Linehan, Prof. of Psychology, Washington; Dale Terilli; at NEA-BPD's "Meet and Greet the Experts"

Perry and I met in 2006 when we both had suites on the same floor in an office building.  Also on the same floor was the office of The Connections Place (TCP), an innovative job preparedness program for those with BPD, which was co-founded by Beth Elliott, Ph.D., and Dale Terilli.  When asked if I would volunteer for TCP, I agreed to conduct mock interviews with their clients, hire those ready to get a job for project work, and give short presentations on workplace issues.  Perry invited me to attend a “Family Connections” training session so that I could better understand the dimensions of BPD behaviors and the impact it has on loved ones.

A serious mental illness diagnosed more often than schizophrenia or bipolar (manic-depressive illness) combined, BPD is prevalent in an estimated 10 million Americans.  According to NEA-BPD, symptoms of BPD include impulsivity, rage, bodily self-harm, recurrent suicidal behavior, unstable relationships, and frequent career changes.  Often diagnosed in young adults, BPD is also diagnosed in adolescents.

A special NEA-BPD Conference, “Genetics to Treatment:  Leaders Speak about Research Findings and Implications” was held at Virginia Commonwealth University in Richmond in early March.  Curious about the role genetics play in the disorder—I see both clients and students who fit that diagnosis plus that was my diagnosis thirty years ago—I attended the conference coordinated by Patricia Woodward, M.A.T., Secretary/Treasurer of the NEA-BPD Board.   Audio and video recordings of the “Genetics to Treatment” conference are available at the NEA-BPD website.

“The degree to which Borderline Personality Disorder is caused by inborn factors called the ‘level of inheritability’ is estimated to be 68%,” states Dr. John Gunderson in a booklet entitled, “A BPD Brief:  An Introduction to Borderline Personality Disorder—Diagnosis, Origins, Course, and Treatment.”  BPD itself is not inherited, he and the other excellent presenters stressed.  It is the biogenetic dispositions that are passed along he emphasized during his presentation on the “Development of BPD” which included the genetics of BPD.  An elder in the field of BPD, Dr. Gunderson is both a Professor of Psychiatry, Harvard Medical School, and Director, Center for Treatment and Research on BPD, Mclean Hospital, Belmont, MA.

The first presenter of the day thankfully was Dr. Kenneth S. Kendler, Rachel Brown Banks Distinguished Professor of Psychiatry at the Virginia Commonwealth University; Professor of Human Genetics; Director, Psychiatric Genetics Research Program; Director, Virginia Institute for Psychiatric and Behavioral Genetics.  I was very glad that my mind was sharp early in the day and that I was sitting in the third row; I could focus my total attention on the details of the research he shared and actually understand the information he conveyed.

Instead of the details, however, following are some of the conclusions of Dr. Kendler’s presentation:  “All major psychiatric and drug use disorders are heritable, although the degree of genetic influence differs substantially across disorders.  For many disorders, gene action on psychiatric disorders is not static but rather is developmentally dynamic.  For many disorders, genetic and environmental risk factors do not just ‘add’ together.  Rather, genes influence:  sensitivity to the pathogenic effect of environment stressors; probability of exposure to high risk environments.  Discovering risk genes for psychiatric disorders is not purely academic as they provide the best chance we have for understanding the biological substrate of these disorders and identifying potentially new drug targets.”

John G. Gunderson, MD; Robert O. Friedel, MD; Kenneth S. Kendler, MD

How does all this information apply to managers in the workplace and what they need to know about employees’ behaviors?

 One way to answer that question was part of the presentation by Dr. Robert O. Friedel, Distinguished Clinical Professor of Psychiatry, Virginia Commonwealth University, and Professor Emeritus, University of Alabama at Birmingham, who spoke about “The Treatment of BPD with Medications:  A Neurobiological Approach.”  Dr. Fiedel is the author of Borderline Personality Disorder Demystified:  An Essential Guide for Understanding and Living with BPD.  He wrote the book for two reasons:  to fill the need for more factual information on the disorder and, since he knew how his sister had suffered with BPD, to try to help those with BPD.

One of the first slides he put on the screen was a picture of his sister Denise, a poignant look at a woman whose life was interrupted by a range of behaviors that evoked much pain and sorrow for her and her loved ones.  Thanks to innovative therapeutic approaches and the research by the presenters and their colleagues around the world, there is a greater understanding of how to manage the appropriate medications creating a more positive  prognosis for recovery from BPD.

Attending the “Genetics to Treatment” conference was challenging and extremely informative.   It has given me greater confidence in having conversations with students who I think would find a visit to the college’s counseling center helpful.  Using the appropriate language for a referral as an instructor is important.  It is also important if you are a manager and need to suggest that an employee would benefit from speaking with someone and that they can, for instance, contact the Employee Assistance Program coordinator at your company for help.  I never mention exactly why I think someone should see a counselor; that would be a diagnosis and I am not qualified to do that.  What I mention is that talking with someone might be helpful to get through a stressful period or to deal with an issue now rather than later in life.

Often individuals, managers, or loved ones think that if a person tries hard enough, they can control their moods or behaviors at work or home.  In truth, that’s not always the case, as I know from personal experience.  People need treatment for disorders like BPD, treatment with a mental health professional who may or may not prescribe medications.  However, as is becoming clearer and clearer in the field of personality disorders and other mental illnesses, genetics are lighting the path to the development of effective medications, a breakthrough for an even brighter outlook for those with BPD.

“Addiction Treatment: Past, Present, and Future” was the topic for the April meeting of the New York City Chapter of the Employee Assistance Professionals Association (EAPA).  I’m a member of the organization and Co-Chair of the EAPA-Women’s Issues Committee and I found the meeting an interesting historical look at the evolution of treatment centers and the predictions the audience made on how to address unmet and complex needs of addicted individuals and families.

EAPA’s purpose is to help meet an employee’s needs to fulfill their responsibilities at work by providing referrals to counselors and offering educational and wellness programs to those who are having problems with their job performance.  Addiction is a major reason for employee referrals.  In addition to alcohol and drug addictions, current approaches to addiction issues include the expansion of treatment of food, gambling, sex, and other process addictions—including work.  Yes, people can work too much—and that can be a sign of substituting work for nurturing relationships in one’s personal life.

Todd Whitmer

Todd Whitmer, Vice-President-Development, Caron New York and Caron Treatment Services, engaged the audience as almost co-presenters of the program.  Whitmer’s effective approach led to an interactive and very interesting meeting during which he asked the many people he knew in the audience to give their input on the history of field and the current parameters of treatment.  There were at least two professionals in the audience—which included EAP providers, psychotherapists, marketing directors of treatment centers, etc.—who had been in the field for over 30 years.

The professional reason I joined EAPA and attend meetings such as this was to expand my knowledge base.  Since 2000, I’ve both coached psychotherapists and gotten numerous client referrals from psychotherapists to address the workplace dimension of their clients’ lives.  I also attend these meetings to gather and pass on relevant information to my executive clients about why one of their employees might be acting the way they are and not living up to expectations.  And, I go because I want to gather and share statistics and treatment options with my undergraduate management students at the Zicklin School of Business for their own development and in their roles as managers.

According to the National Council on Alcoholism and Drug Dependencies, Inc., (NCADD) about 22.2 million people in the U.S. are addicted to alcohol and other drugs.  Of that number, 15.4 million are addicted to alcohol alone, 3.6 million illicit drugs—no alcohol, and 3.3 million illicit drugs and alcohol.

The annual cost of alcohol and drug problems—productivity, accidents, etc.?  $400 billion!

Whitmer spoke about the treatment options that Caron offers, including a young adult program for 18-26 year olds.  When I asked, “How many young adults are addicts?” he replied, “Lots.”  No one in the audience knew.  This specific population is not easy to quantify yet probably easy to identify by family, friends,  and educators.  In fact, a growing topic of discussion and action is, “Internet” addiction, something that is making headlines—and it’s not just the behavior of young adults that is drawing attention.

Nearing the end of the program, Whitmer asked the audience to form into groups of four and brainstorm to “Predict five years from now addiction treatment will be improved by__________.”  This was an interesting and insightful process with many groups coming up with innovative and thoughtful ideas.  In my group, we emphasized a continuous need for tools for treatment of this chronic condition, treatment that would be supported by health insurance; a chip that could be implanted in an addict’s brain (not my idea) that would help manage the impulses for addictive behavior; and, my idea enhanced by my group, videos and digital games that could be used to address both prevention and treatment.

Thanks, Todd, for a great program.  It obviously has helped my working to be a better leader.